Ambulance Invoice Template


An ambulance invoice is a one-page form used for billing a patient that received emergency transportation to a nearby hospital. An emergency medical service (EMS) provider sends the invoice to the patient after they receive care. The form reflects the services rendered to the patient and the amount owed to pay employees and cover expenses.

On average, an ambulance ride costs between $1000 and $2000 per incident. The EMS provider can bill the insurance company directly if the patient has a policy that covers medical transportation. Otherwise, the patient must be billed directly.

File Types (3)

How to Charge for Ambulance Services

EMS providers charge patients by the mile, service, or at a flat-rate fee. Companies that use a base fee request a set amount regardless of the services provided. However, they charge extra for complex care, such as providing oxygen or defibrillation. Similarly, the patient pays more if the emergency medical technician (EMT) drives more than a certain number of miles to the hospital.

Other companies charge clients based on the services rendered and/or mileage. In this case, each service has a specific price while every mile costs a certain amount. For example, a patient who received an intravenous drip would be charged differently than someone who was given medication. Similarly, a patient owes between $7 and $20 per mile. These rates are dependent on the company’s expenses, such as employee pay, supply costs, and vehicle expenses.